Approach to Headache in Emergency Department

Headache remains a frequently encountered neurological symptom in Emergency department. Secondary causes of headache outnumber the primary entities such as migraine. Most of the secondary headaches have benign etiologies. The goal of emergent evaluation is to detect those with serious or life threatening causes. Identifying the pattern of headache helps in narrowing down the possible etiological diagnosis. A single episode of acute headache usually results from an acute infection ranging from viral URI to acute meningitis. Acute recurrent headaches are typically a feature of migraine. Chronic progressive headaches often indicate a serious underlying pathology such as a brain tumor and warrant a detailed neurological examination for signs of raised intracranial pressure (ICP) and focal deficits. Children with abnormal neurological findings require a neuroimaging. CT scan usually detects most of the abnormalities. Initial stabilization and management of raised ICP takes precedence in sick children. While simple analgesics like paracetamol and ibuprofen are used for symptomatic therapy, identification and appropriate treatment of underlying conditions is necessary for complete resolution of headache.